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Pereyra-Rodríguez JJ, Poveda JL, Rivero A, Serra-Baldrich E, Silvestre JF, Armario-Hita JC, Calleja MÁ, Carrascosa JM, Flórez Á, Herranz P, Comellas M, Ortiz de Frutos FJ. Assessing the value of moderate-to-severe atopic dermatitis treatment using multi-criteria decision analysis (MCDA). J Eur Acad Dermatol Venereol 2024; 38:e59-e62. [PMID: 37594914 DOI: 10.1111/jdv.19432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/11/2023] [Indexed: 08/20/2023]
Affiliation(s)
| | - J L Poveda
- Pharmacy Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - A Rivero
- Independent Consultant Agustin Rivero, Madrid, Spain
| | - E Serra-Baldrich
- Dermatology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autónoma, Barcelona, Spain
| | - J F Silvestre
- Dermatology Department, Hospital General Universitario Dr Balmis-ISABIAL-UMH, Alicante, Spain
| | - J C Armario-Hita
- Dermatology Department, Hospital Universitario de Puerto Real, University of Cádiz, Cádiz, Spain
| | - M Á Calleja
- Pharmacy Department, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - J M Carrascosa
- Dermatology Department, Hospital Universitari Germans Trias i Pujol, Autonomous University of Barcelona, Barcelona, Spain
| | - Á Flórez
- Dermatology Department, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - P Herranz
- Dermatology Department, Hospital Universitario La Paz, Madrid, Spain
| | - M Comellas
- Outcomes Research Department, Outcomes'10, Castellón de la Plana, Spain
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2
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Fernandez Rivera C, Calvo Rodríguez M, Poveda JL, Pascual J, Crespo M, Gomez G, Cabello Pelegrin S, Paul J, Lauzurica R, Perez Mir M, Moreso F, Perelló M, Andres A, González E, Fernandez A, Mendiluce A, Fernández Carbajo B, Sanchez Fructuoso A, Calvo N, Suarez A, Bernal Blanco G, Osuna A, Ruiz-Fuentes MC, Melilli E, Montero Perez N, Ramos A, Fernández B, López V, Hernandez D. Bioavailability of once-daily tacrolimus formulations used in clinical practice in the management of De Novo kidney transplant recipients: the better study. Clin Transplant 2021; 36:e14550. [PMID: 34851532 PMCID: PMC9285676 DOI: 10.1111/ctr.14550] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 10/26/2021] [Accepted: 11/13/2021] [Indexed: 12/21/2022]
Abstract
Multicenter, prospective, observational study to compare the relative bioavailability of once‐daily tacrolimus formulations in de novo kidney transplant recipients. De novo kidney transplant recipients who started a tacrolimus‐based regimen were included 14 days post‐transplant and followed up for 6 months. Data from 218 participants were evaluated: 129 in the LCPT group (Envarsus) and 89 in the PR‐Tac (Advagraf) group. Patients in the LCPT group exhibited higher relative bioavailability (Cmin /total daily dose [TDD]) vs. PR‐Tac (61% increase; P < .001) with similar Cmin and 30% lower TDD levels (P < .0001). The incidence of treatment failure was 3.9% in the LCPT group and 9.0% in the PR‐Tac group (P = .117). Study discontinuation rates were 6.2% in the LCPT group and 12.4% in the PR‐Tac group (P = .113). Adverse events, renal function and other complications were comparable between groups. The median accumulated dose of tacrolimus in the LCPT group from day 14 to month 6 was 889 mg. Compared to PR‐Tac, LCPT showed higher relative bioavailability, similar effectiveness at preventing allograft rejection, comparable effect on renal function, safety, adherence, treatment failure and premature discontinuation rates.
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Affiliation(s)
| | | | | | - Julio Pascual
- Nephrology Department, University Hospital del Mar, Barcelona, Spain
| | - Marta Crespo
- Nephrology Department, University Hospital del Mar, Barcelona, Spain
| | - Gonzalo Gomez
- Nephrology Department, University Hospital Son Espases, Palma de Mallorca, Spain
| | | | - Javier Paul
- Nephrology Department, Hospital Miguel Servet, Zaragoza, Spain
| | - Ricardo Lauzurica
- Nephrology Department, University Hospital Germans Trias y Pujol, Badalona, Spain
| | - Mònica Perez Mir
- Nephrology Department, University Hospital Germans Trias y Pujol, Badalona, Spain
| | - Francesc Moreso
- University Hospital Vall d'Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Nephrology Department, Barcelona, Spain
| | - Manel Perelló
- University Hospital Vall d'Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Nephrology Department, Barcelona, Spain
| | - Amado Andres
- Nephrology Department, University Hospital Doce de Octubre, Madrid, Spain
| | - Esther González
- Nephrology Department, University Hospital Doce de Octubre, Madrid, Spain
| | - Ana Fernandez
- Nephrology Department, University Hospital Ramón y Cajal, Madrid, Spain
| | - Alicia Mendiluce
- Nephrology Department, University Hospital Clínico de Valladolid, Valladolid, Spain
| | | | | | - Natividad Calvo
- Nephrology Department, University Hospital Clínico San Carlos, Madrid, Spain
| | - Alejandro Suarez
- Nephrology Department, University Hospital Virgen del Rocio, Sevilla, Spain
| | | | - Antonio Osuna
- Nephrology Department, University Hospital Virgen de las Nieves, Granada, Spain
| | | | - Edoardo Melilli
- Nephrology Department, University Hospital Bellvitge, Hospitalet de Llobregat, Spain
| | - Nuria Montero Perez
- Nephrology Department, University Hospital Bellvitge, Hospitalet de Llobregat, Spain
| | - Ana Ramos
- Nephrology Department, Fundación Jiménez Díaz, Madrid, Spain
| | | | - Verónica López
- University Hospital Regional, Málaga, IBIMA, University of Málaga, REDinREN (RED16/0009/0006), Nephrology Department, Spain
| | - Domingo Hernandez
- University Hospital Regional, Málaga, IBIMA, University of Málaga, REDinREN (RED16/0009/0006), Nephrology Department, Spain
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Álvarez-Román MT, Cuervo-Arango I, Pérez-Santamarina R, Poveda JL, Romero JA, Santamaría A, Trillo-Mata JL, Tort M, Badia X. Determining the value contribution of emicizumab (Hemlibra®) for the prophylaxis of haemophilia A with inhibitors in Spain by multi-criteria decision analysis. Global & Regional Health Technology Assessment 2019. [DOI: 10.1177/2284240319880534] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Patients with moderate to severe haemophilia A are at a higher risk of developing FVIII inhibitors that require the use of more costly and less effective treatments. The objective of this study was to determine the value of emicizumab for the prophylaxis of haemophilia A with inhibitors compared to the current therapeutic alternatives, activated prothrombin complex concentrate and recombinant factor VIIa through reflective Multi-Criteria Decision Analysis. The EVIDEM framework adapted to orphan drugs and weighted by a sample of 98 national and regional Spanish evaluators was used. Two structured evidence matrices were developed: emicizumab against activated prothrombin complex concentrate and emicizumab against recombinant factor VIIa. A multidisciplinary team of haemophilia experts rated each of the criteria. Mean and standard deviation were calculated by each criterion and discussed among all participants. Haemophilia A with inhibitors was perceived as a severe disease with high unmet needs. Emicizumab was rated with higher efficacy, therapeutic benefit and quality of life than comparators. When administered alone for the prevention of bleeding events, emicizumab had slightly better safety and tolerability profile than activated prothrombin complex concentrate and similar with recombinant factor VIIa. The inclusion of emicizumab in clinical practice guidelines was valued positively by the members of the panel. Overall, value of emicizumab was higher than activated prothrombin complex concentrate and recombinant factor VIIa, mostly because of efficacy and therapeutic benefit in reducing treated haemorrhages. Reflective Multi-Criteria Decision Analysis has proven to be a feasible method to determine the value contribution of comparative therapies in haemophilia.
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Poveda JL, Trillo JL, Rubio-Terrés C, Rubio-Rodríguez D, Polanco A, Torres C. Cost-effectiveness of Cladribine Tablets and fingolimod in the treatment of relapsing multiple sclerosis with high disease activity in Spain. Expert Rev Pharmacoecon Outcomes Res 2019; 20:295-303. [PMID: 31220959 DOI: 10.1080/14737167.2019.1635014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To estimate the cost-effectiveness of Cladribine Tablets in the treatment of relapsing multiple sclerosis (RMS) with high disease activity compared with fingolimod, from the perspective of the National Health System (NHS) in Spain. METHODS A Markov model was developed. The annual transition probabilities, were adjusted to patients with RMS with high disease activity. The effect of the treatments compared on the Expanded Disability Status Scale (EDSS) was modeled by hazard ratios for the confirmed progression of disability. The annual relapse rate and the probability of suffering adverse reactions were obtained from a meta-analysis and the literature. The derived costs were calculated from Spanish unit costs. The utilities were obtained from the CLARITY clinical trial and the literature. Deterministic and probabilistic sensitivity analyzes were performed. RESULTS Cladribine tablets was the dominant treatment: lower costs (-86,536 €) and more effective (+1.11 quality-adjusted life years - QALYs) compared to fingolimod. The probability that Cladribine Tablets was cost-effective compared to fingolimod ranged between 94.6% and 96.1% for willingness to pay from € 20,000 to € 30,000 per QALY gained. CONCLUSIONS Cladribine Tablets is a cost-effective treatment, compared to fingolimod, for the treatment of RMS with high disease activity. EXPERT OPINION According to the present study, compared to fingolimod, treatment with Cladribine Tablets of relapsing multiple sclerosis with high disease activity is an option that could generate savings for the Spanish National Health System, with a considerable gain in QALYs. Cladribine Tablets is considered cost-effective and dominant (less costs and more effectiveness) than fingolimod treatment option in this population.
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Affiliation(s)
- J L Poveda
- Pharmacy Department, Hospital Universitario y Politécnico La Fe , Valencia, Spain
| | - J L Trillo
- Pharmacy Department, Hospital Clínico Universitario de Valencia , Valencia, Spain
| | - C Rubio-Terrés
- Pharmacoeconomics Department, Health Value , Madrid, Spain
| | | | - A Polanco
- Corporate Affairs Department, Merck , Madrid, Spain
| | - C Torres
- Corporate Affairs Department, Merck , Madrid, Spain
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5
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Megías-Vericat JE, Montesinos P, Herrero MJ, Moscardó F, Bosó V, Rojas L, Martínez-Cuadrón D, Rodríguez-Veiga R, Sendra L, Cervera J, Poveda JL, Sanz MÁ, Aliño SF. Impact of NADPH oxidase functional polymorphisms in acute myeloid leukemia induction chemotherapy. Pharmacogenomics J 2018; 18:301-307. [PMID: 28485375 DOI: 10.1038/tpj.2017.19] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 11/22/2016] [Accepted: 01/09/2017] [Indexed: 02/04/2023]
Abstract
Efficacy and toxicity of anthracycline treatment in acute myeloid leukemia (AML) is mediated by reactive oxygen species (ROS). NADPH oxidase is the major endogenous source of ROS and a key mediator of oxidative cardiac damage. The impact of NADPH oxidase polymorphisms (CYBA:rs4673, NCF4:rs1883112, RAC2:rs13058338) was evaluated in 225 adult de novo AML patients. Variant alleles of NCF4 and RAC2 were related to higher complete remission (P=0.035, P=0.016), and CYBA homozygous variant showed lower overall survival with recessive model (P=0.045). Anthracycline-induced cardiotoxicity was associated to NCF4 homozygous variant (P=0.012) and CYBA heterozygous genotype (P=0.027). Novel associations were found between variant allele of CYBA and lower lung and gastrointestinal toxicities, and a protective effect in nephrotoxicity and RAC2 homozygous variant. Moreover, RAC2 homozygous variant was related to delayed thrombocytopenia recovery. This study supports the interest of NADPH oxidase polymorphisms regarding efficacy and toxicity of AML induction therapy, in a coherent integrated manner.
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Affiliation(s)
- J E Megías-Vericat
- Unidad de Farmacogenética, Instituto Investigación Sanitaria La Fe and Área del Medicamento, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Servicio de Farmacia, Área del Medicamento, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - P Montesinos
- Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - M J Herrero
- Unidad de Farmacogenética, Instituto Investigación Sanitaria La Fe and Área del Medicamento, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Facultad de Medicina, Departamento Farmacología, Universidad de Valencia, Valencia, Spain
| | - F Moscardó
- Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - V Bosó
- Unidad de Farmacogenética, Instituto Investigación Sanitaria La Fe and Área del Medicamento, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Servicio de Farmacia, Área del Medicamento, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - L Rojas
- Unidad de Farmacogenética, Instituto Investigación Sanitaria La Fe and Área del Medicamento, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Faculty of Medicine, Department of Internal Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - D Martínez-Cuadrón
- Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - R Rodríguez-Veiga
- Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - L Sendra
- Unidad de Farmacogenética, Instituto Investigación Sanitaria La Fe and Área del Medicamento, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Facultad de Medicina, Departamento Farmacología, Universidad de Valencia, Valencia, Spain
| | - J Cervera
- Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - J L Poveda
- Servicio de Farmacia, Área del Medicamento, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - M Á Sanz
- Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - S F Aliño
- Unidad de Farmacogenética, Instituto Investigación Sanitaria La Fe and Área del Medicamento, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Facultad de Medicina, Departamento Farmacología, Universidad de Valencia, Valencia, Spain
- Unidad de Farmacología Clínica, Área del Medicamento, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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6
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Torrent-Farnell J, Comellas M, Poveda JL, Abaitua I, Gutiérrez-Solana LG, Pérez-López J, Cruz J, Urcelay J, Lizán L. The view of experts on initiatives to be undertaken to promote equity in the access to orphan drugs and specialised care for rare diseases in Spain: A Delphi consensus. Health Policy 2018; 122:590-598. [PMID: 29572017 DOI: 10.1016/j.healthpol.2018.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 02/09/2018] [Accepted: 03/07/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To reach a consensus amongst experts on the most feasible actions to be undertaken to facilitate patient access to specialised care and orphan drugs (OD) in the public health sector in Spain. METHODS Two Delphi rounds were completed. The questionnaire was based on a literature review and 2 focus groups. Agreement was sought on the desire (D) and prognosis (P) for the implementation within the next 5 years, on a 5-point Likert scale. Consensus was reached when ≥75% participants chose agreement (1-2) or disagreement options (4-5). RESULTS 82 experts on rare disease (RD) participated. Agreement on the D and P was reached in 66.07% statements: OD pricing review [absence of clinical effectiveness (D:85.37%; P:85.90%), target population increase (D:79.27%; P:91.03%)]; reference team definition of referral protocols and clinical practice guidelines (D: 97.56%; P: 89.74%); and a unified, usable, etiology-based registry (D:97.56%; P:84.62%). D and P assessment diverged in 32.14% items: creation of a specific funding system for OD (D: 97.56%; P: 60.25%); and a network of medical teams to coordinate the care of RD patients (D: 99%; P: 62%). CONCLUSIONS The results have shown the need to promote dialogue between stakeholders, introduce European recommendation to national and regional Spanish policies and set up priorities and undertake actions to drive relevant changes in current medical practice in managing RD patients.
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Affiliation(s)
- J Torrent-Farnell
- Committee for Orphan Medicinal Products (COMP), European Medicines Agency (EMA), London, UK; Autonomous University, Barcelona, Spain
| | | | - J L Poveda
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - I Abaitua
- Instituto de Investigación de Enfermedades Raras del Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | | | - J Pérez-López
- Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - J Cruz
- Federación Española de Enfermedades Raras (FEDER), Madrid, Spain
| | - J Urcelay
- Shire, Madrid, Spain; Spanish Association of Laboratories for Orphan and Ultra-Orphan Drugs [Asociación Española de Laboratorios de Medicamentos Huérfanos y Ultrahuérfanos (AELMHU)], Madrid, Spain
| | - L Lizán
- Outcomes'10, Castellon, Spain
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Company-Albir MJ, Ruíz-Ramos J, Solana Altabella A, Marqués-Miñana MR, Vicent C, Poveda JL. Haemodialysis significantly reduces serum levetiracetam levels inducing epileptic seizures: Case report. J Clin Pharm Ther 2017; 42:774-775. [PMID: 28555936 DOI: 10.1111/jcpt.12568] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 05/04/2017] [Indexed: 12/30/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Levetiracetam is used in the treatment of some forms of epilepsy. In renal impairment and patients on chronic haemodialysis, dose adjustment is required. We report a case. CASE DESCRIPTION This case report describes a woman on levetiracetam treatment who presented with generalized tonic-clonic seizures during a haemodialysis session. We report on treatment adjustment and on the impact of dialysis on levetiracetam levels. WHAT IS NEW AND CONCLUSION Haemodialysis reduces serum levetiracetam concentration and can lead to subtherapeutic levels. Close monitoring is necessary when dialysis is used on patients receiving anticonvulsant drugs that are extensively eliminated by the procedure.
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Affiliation(s)
- M J Company-Albir
- Servicio de Farmacia, Área del Medicamento, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - J Ruíz-Ramos
- Unidad de Cuidados Intensivos, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - A Solana Altabella
- Servicio de Farmacia, Área del Medicamento, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - M R Marqués-Miñana
- Servicio de Farmacia, Área del Medicamento, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - C Vicent
- Unidad de Cuidados Intensivos, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - J L Poveda
- Servicio de Farmacia, Área del Medicamento, Hospital Universitari i Politècnic La Fe, Valencia, Spain
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Megías Vericat JE, Montesinos P, Herrero MJ, Bosó V, Moscardó F, Rojas L, Martínez-Cuadrón D, Aliño SF, Sanz MA, Poveda JL. PKP-020 Impact of nadph oxidase functional polymorphisms in acute myeloid leukaemia induction chemotherapy. Eur J Hosp Pharm 2016. [DOI: 10.1136/ejhpharm-2016-000875.423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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9
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Megías-Vericat JE, Rojas L, Herrero MJ, Bosó V, Montesinos P, Moscardó F, Poveda JL, Sanz MA, Aliño SF. Positive impact of ABCB1 polymorphisms in overall survival and complete remission in acute myeloid leukemia: a systematic review and meta-analysis. Pharmacogenomics J 2015; 16:1-2. [DOI: 10.1038/tpj.2015.79] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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10
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Megías-Vericat JE, Rojas L, Herrero MJ, Bosó V, Montesinos P, Moscardó F, Poveda JL, Sanz MÁ, Aliño SF. Influence of ABCB1 polymorphisms upon the effectiveness of standard treatment for acute myeloid leukemia: A systematic review and meta-analysis of observational studies. Pharmacogenomics J 2015; 15:109-18. [DOI: 10.1038/tpj.2014.80] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 10/15/2014] [Accepted: 11/07/2014] [Indexed: 11/09/2022]
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Sole A, Poveda JL, Giron RM, Prados MC, De GJ, Casado MÁ. Economic Impact Linked To the Reduction of Exacerbations When A Treatment Regime With Inhaled Antibiotics Is Switched To Aztreonam Lysine In Patients With Cystic Fibrosis and Chronic Pulmonary Infection Caused By Pseudomonas Aeruginosa. Value Health 2014; 17:A526. [PMID: 27201659 DOI: 10.1016/j.jval.2014.08.1659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- A Sole
- Hospital Universitario La Fe, Valencia, Spain
| | - J L Poveda
- Hospital Universitario La Fe, Valencia, Spain
| | | | - M C Prados
- Hospital Universitario La Paz, Madrid, Spain
| | - Gracia J De
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - M Á Casado
- Pharmacoeconomics & Outcomes Research Iberia, Madrid, Spain
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Abstract
OBJECTIVE To summarize available information on share risk agreements (RSA) with orphan drugs (OD). METHODS A bibliographic search was carried out in MEDLINE, EMBASE and INAHTA using 19 keywords and combinations thereof. Papers published as original, narrative and systematic reviews, editorials, commentaries, letters to the Editor, and special articles were included and reviewed. Public or private institutional reports or documents found in Google that contained relevant information were also reviewed. RESULTS experience gained so far with RSA is scant. No published rigorous evaluations of outcomes of these agreements were found. It seems, however, that OD are suitable for introduction in clinical practice by means of RSA. There are two main types of RSA: financially based, and performance-outcome based. A number of theoretical advantages of SRA are described, as well as hurdles that hinder their design, implementation, and followup, and thus endangering their success. Very few RSA have clearly succeed so far. CONCLUSIONS If thoroughly managed, RSA may reasonably contribute to value-based pricing of OD, improve their pharmacovigilance, knowledge about their comparative effectiveness, and to reducing uncertainty and its consequences on patients, industry, payers and clinicians. There are technical groups that can bring the essential knowledge to manage RSA in Spain. The challenge now is to be able to harmonize their assessments and appraisals, to put in motion the mechanisms needed to overcome those hurdles, and to provide them adequate political and institutional support.
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Valero S, Marrero P, Lorente L, Gil I, Monte E, Poveda JL. GRP-186 The Quality of Oral Chemotherapy Prescribing in Oncohaematologial Outpatients. Eur J Hosp Pharm 2013. [DOI: 10.1136/ejhpharm-2013-000276.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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14
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Borrell C, Esteban MJ, Ruiz J, Megías JE, López E, Poveda JL. DGI-056 Reduced Delay in the Administration of Chemotherapy After Optimising the Process of Preparation/Dispensing of Parenteral Antineoplastics. Eur J Hosp Pharm 2013. [DOI: 10.1136/ejhpharm-2013-000276.322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ruiz J, García A, Pérez P, Cueto M, Marqués R, Poveda JL. PHC-005 Blood Levels of Immunosuppressant Drugs in Patients with Cystic Fibrosis After Lung Transplantation. Eur J Hosp Pharm 2013. [DOI: 10.1136/ejhpharm-2013-000276.350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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16
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Marrero P, Lorente L, Valero S, Gil I, Monte E, Ruiz J, Reig J, Poveda JL. DGI-061 Safety of Triple Treatment in Chronic Hepatitis C. Eur J Hosp Pharm 2013. [DOI: 10.1136/ejhpharm-2013-000276.327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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17
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Hernández-Martin J, Romá E, Salavert M, Doménech L, Poveda JL. [Cefditoren pivoxil: A new oral cephalosporin for skin, soft tissue and respiratory tract infections]. Rev Esp Quimioter 2006; 19:231-46. [PMID: 17099791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Cefditoren pivoxil, a new-third generation cephalosporin antibiotic that has recently been granted approval in Spain, shows important activity over a large part of the pathogens causing skin, soft tissue and respiratory tract infections, including Gram-negative and Gram-positive bacteria. Cefditoren has also been shown to be stable against hydrolysis by many common beta-lactamases. Data from in vitro studies and clinical trials show this antibiotic as an oral formulation with an intrinsic activity against Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pneumoniae equivalent to that of other third-generation cephalosporins administered via parenteral, like cefotaxime or ceftriaxone, thereby placing its maximal benefits mainly in the treatment of ambulatory infections. This paper reviews the main characteristics of cefditoren pivoxil (spectrum of activity, chemical structure, mechanism of action, pharmacokinetics, adverse effects and clinical efficacy) and attempts to find its place in current antibiotic therapeutics.
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Affiliation(s)
- J Hernández-Martin
- Servicio de Farmacia, Hospital Universitario La Fe, Avda. Campanar No. 21, 46009 Valencia, Spain.
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Jarque I, Salavert M, Romá E, Gobernado M, Chiveli MA, Ruano M, Solé A, Poveda JL, Ferrer E, García-Pellicer J, Sanz MA, Pemán J, Sánchez V. [Hospital Universitario La Fe Guide to the prophylaxis and treatment of fungal infections in immunodepressed patients or in patients requiring special care]. Rev Esp Quimioter 2004; 17:357-89. [PMID: 15696227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Affiliation(s)
- I Jarque
- Servicio de Hematología Clínica, Hospital Universitario La Fe, Valencia
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Abstract
Fractionation of an ethanolic extract of the leaves of Phenax angustifolius has resulted in the isolation of two new lignans, 2-hydroxy-2-(3',4'-dihydroxyphenyl)methyl-3-(3' ',4' '-dimethoxyphenyl)methyl-gamma-butyrolactone (1) and 2-hydroxy-2-(4'-O-beta-D-glucopyranosyl-3'-hydroxyphenyl)methyl-3-(3' ',4' '-dimethoxyphenyl)methyl-gamma-butyrolactone (2), and three known compounds, vitexin, isovitexin, and quercetin 3-O-alpha-L-rhamnopyranoside. The structures of 1 and 2 were determined using spectroscopic methods.
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Affiliation(s)
- L Rastrelli
- Dipartimento di Scienze Farmaceutiche, Università di Salerno, Invariante 11/C, 84084 Fisciano, Salerno, Italy
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Sánchez-Alcaraz A, Vargas A, Quintana MB, Rocher A, Querol JM, Poveda JL, Hermenegildo M. Therapeutic drug monitoring of tobramycin: once-daily versus twice-daily dosage schedules. J Clin Pharm Ther 1998; 23:367-73. [PMID: 9875685 DOI: 10.1046/j.1365-2710.1998.00174.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the effect of dosage regimen (once-daily vs. twice-daily) of tobramicyn on steady-state serum concentrations and toxicity. MATERIALS AND METHODS Patients undergoing treatment with i.v. tobramycin (4 mg/kg/day) were randomised to two groups. Group OD (n = 22) received a once-daily dose of tobramycin and group TD (n = 21) received the same dose divided into two doses daily. Tobramycin serum concentrations (peak and trough) were measured by enzyme multiplied immunoassay. The renal and auditory functions of the patients were monitored before, during and immediately after treatment. RESULTS The two groups were comparable with respect to sex, age, body weight and renal function. No statistically significant differences were found in mean daily dose, duration of treatment, or cumulative dose. Trough concentrations were < 2 g/ml in the two groups (100%). Peak concentrations were > 6 microg/ml in 100% of the OD group and in 67% of the TD group (P< 0.01). Mean peak concentrations were markedly different: 11.00+/-2.89 microg/ml in OD vs. 6.53+/-1.45 microg/ml in TD (P< 0.01). The pharmacokinetics parameters were: Ke, (0.15+/-0.03/h in OD vs. 0.24+/-0.06/h in TD), t1/2, (4.95+/-1.41 h in OD vs. 3.07+/-0.71 h in TD), Vd (0.35+/-0.11 l/kg in OD vs. 0.33+/-0.09 l/kg in TD), Cl (0.86+/-0.29 ml/min/kg in OD vs. 1.28+/-0.33 ml/min/kg in TD). Increased serum creatinine was observed in 73% of patients in OD versus 57% of patients in TD, without evidence of nephrotoxicity. In TD group, three patients developed decreased auditory function, of which one presented with an auditory loss of -30 dB, whereas in the OD group only one patient presented decreased auditory function. CONCLUSION This small study suggests that a once-daily dosing regimen of tobramycin is at least as effective as and is no more and possibly less toxic than the twice-daily regimen. Using a single-dose therapy, peak concentration determination is not necessary, only trough samples should be monitored to ensure levels below 2 microg/ml.
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Ordovás JP, Ronchera CL, Poveda JL, Jiménez NV, López R. Selection of optimal prophylactic aminoglycoside dosage in cancer patients: population pharmacokinetic approaches. J Clin Pharm Ther 1994; 19:47-56. [PMID: 8188791 DOI: 10.1111/j.1365-2710.1994.tb00809.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We report an alternative dose-finding approach for the selection of optimal prophylactic aminoglycoside dosage in specific (sub)populations of patients. Relative a priori utility of several intervals of gentamicin or tobramycin (AMG) peak and trough serum levels were assigned by a group of pharmacokinetics experts, assuming prophylactic administration for laryngectomy interventions. A group of 27 adult patients, with normal renal function, undergoing elective surgery for laryngeal problems and treated prophylactically with gentamicin (80 mg t.i.d.) or tobramycin (100 mg t.i.d.) was studied. Two blood samples (peak and trough) were drawn at steady-state for AMG assay. Three different methods, standard two-stage (STS), extended least-squares non-linear regression [MULTI(ELS)] and non-parametric expected maximization (NEPM), were used to estimate the pharmacokinetic (PK) population parameters. PK simulations were applied to estimate the AMG steady-state concentrations from the PK population parameters. From these data, relative utility values were calculated, allowing the selection of the optimal dosage schedule for this group of patients. There were no statistically significant differences between the PK population estimates as generated by the three methods. Using the STS estimates, the simulation of several dosages indicated that the optimal dosage is 170 mg every 8 h. Conversely, using the individual PK parameters and the mean AMG levels simulated from them, the dose with best relative utility is 130 mg every 8 h. This important difference points out the relevance of the use of relative utilities for the AMG serum concentrations in the selection of optimal a priori dosage. We propose the use of 120 mg every 8 h as the safer dose for our population. Further studies are needed to validate this proposal in patients similar to ours.
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Affiliation(s)
- J P Ordovás
- Pharmacy Service, Hospital Dr Peset, Valencia, Spain
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